Radiation safety training has moved from textbooks, to e-learning, to simulation that lets learners see radiation for themselves. This article follows that journey, explains why each step mattered, and summarises what peer-reviewed studies now show about virtual reality (VR) training and staff dose.
Key points
- The principles of radiation protection have been taught for almost a century. The hard part has always been applying them to something you cannot see.
- E-learning widened access to training, but the content stayed largely theoretical.
- VR simulation makes scatter visible and lets learners test decisions safely. In a randomised crossover trial, staff received less measured radiation dose after VR training than after traditional training.
Where radiation safety training began
Wilhelm Röntgen discovered X-rays in 1895, and medical use followed almost immediately. So did harm: early X-ray workers suffered skin burns and other injuries long before anyone understood the risks. In 1928, growing concern in the medical community led to the founding of the International X-ray and Radium Protection Committee, now the International Commission on Radiological Protection (ICRP) [1].
For most of the century that followed, training meant textbooks, lectures, and supervised practice. Learners studied radiation physics and biology, and the core principles of protection: justification, optimisation, and dose limitation [2]. In daily practice those principles become time, distance, and shielding.
The problem with learning from the page
Textbook training teaches the rules well. What it struggles to teach is judgement in the room. Radiation is invisible, scatter changes with every change of tube angle, patient size, and staff position, and the consequences of a poor decision are not felt at the time. A learner can know the inverse square law and still stand in the wrong place during a procedure.
The move to e-learning
Online courses and webinars made radiation safety training easier to deliver, update, and track across large organisations. Videos and animations helped explain concepts. But most e-learning still asks learners to read, watch, and answer questions. It rarely lets them make a decision and see what it does to dose.
Simulation: seeing what radiation does
VR and desktop simulation change the learning task. Instead of reading about scatter, learners see it, change something, and see it again. Each decision has a visible result, and the scenario can be repeated as often as needed with no exposure to patients, colleagues, or learners.
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Visualise scatter
See how scattered radiation spreads around the patient and the imaging system.
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Test position and shielding
Move staff and shields, then compare the dose at each location.
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Change the procedure
Adjust tube angle, exposure settings, and patient size, and watch the radiation environment respond.
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What the research shows
The evidence base for VR radiation safety training is growing, and several studies now measure real occupational dose rather than only knowledge or confidence.
Measured dose in clinical staff
In a two-year randomised crossover trial, 39 interventional cardiologists, surgeons, and theatre nurses received either RadSafe VR training or traditional didactic training, then swapped. Dosimeter readings were lower after VR training in every professional group, by between about 32% and 60%, and the VR training took 2 hours compared with 4 hours for didactic training [3].
Nurses in procedural settings
Crossover studies of scrub nurses in cardiac catheterisation labs [4] and of interventional radiology nurses across several hospitals [5] have also compared VR with traditional radiation safety training using measured occupational dose.
Students
At University College Dublin, radiography and medical students used a VR interventional radiology suite for radiation protection training. Of those who responded, 80% enjoyed the experience, 73% said it improved their confidence, and 87% would recommend it to other students [6].
VR complements, it does not replace
Simulation works best alongside formal teaching, local rules, dosimetry, and supervised clinical practice, with the radiation safety officer (RSO) involved. Most studies so far are small or single-centre, so larger multicentre trials will strengthen the evidence further.
How RadSafe VR applies this
RadSafe VR is modelled on the Siemens Healthineers ARTIS icono interventional imaging system. Its radiation output was calibrated with the involvement of medical physicists, and external medical physicists have benchmarked its simulated scatter and occupational dose against physical measurements [7].
It includes the Radiation Safety Workshop: eight short self-assessment lessons, completed in as little as 20 minutes. Each lesson compares best practice with a common poor practice, covering lead shielding, protective eyewear, tube position for left and right laterals, source-to-image distance, patient size, dose rate, and collimation. Results are saved to each learner's portfolio, which the RSO or educator can view.
VR Desktop
Frequently asked questions
How does VR improve radiation safety training?
It makes radiation visible. Learners can see how scatter changes when they move, add shielding, or change equipment settings, and repeat scenarios without any real exposure.
Can VR replace traditional radiation safety training?
No. It works best as part of a programme that also includes formal teaching, local rules, and supervised clinical practice.
Is there evidence that VR training reduces staff dose?
Yes. In a randomised crossover trial, clinical staff received lower measured dose after VR training than after didactic training [3]. Further studies in nursing groups support this [4, 5].
Who is radiation safety simulation for?
Anyone who works around fluoroscopy and medical imaging, including radiographers, interventional clinicians, surgeons, nurses, theatre teams, and students preparing for clinical placement.
References
- International Commission on Radiological Protection. ICRP history. icrp.org
- ICRP. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP. 2007;37(2-4). icrp.org
- Mwangi W, Tanaka Y. Comparative effectiveness of immersive virtual reality and traditional didactic training on radiation safety in medical professionals: a crossover study. J Med Radiat Sci. 2025;72(Suppl 2):S52-S60. doi.org/10.1002/jmrs.867
- Romanenko. Virtual reality vs traditional training in radiation safety for scrub nurses: a crossover trial in cardiac catheterisation labs. 2026. doi.org/10.12968/jpoc.2026.0005
- Khamis. Assessing the impact of virtual reality training on radiation dose reduction among interventional radiology nurses: a multicenter crossover study. 2025. sciencedirect.com
- Rainford L, Tcacenco A, Potocnik J, Brophy C, Lunney A, Kearney D, O'Connor M. Student perceptions of the use of three-dimensional virtual reality simulation in the delivery of radiation protection training for radiography and medical students. Radiography. 2023. sciencedirect.com
- Virtual Medical Coaching. RadSafe VR: radiation safety simulation. virtualmedicalcoaching.com